Moore: Claim Contact Deadline Still 24 Hours

Friday, September 13, 2024 | 0

After receiving a first report of injury, how quickly the injured worker receives contact from the claims adjuster remains a critical element. 

James Moore

Twenty-four business hours do not count. The deadline has to be 24 hours, even if the first report of injury arrives on at 4 p.m. on a Friday.

With our risk management claims reviews, one area of the three-point contact by claims adjusters has now become increasingly important.

The three-point contact consists of three parties (not in any specific order):

• Injured worker.
• Treating physician.
• Employer/insured contact.

In the age of smartphones and instant information, the time when the injured employee expects contact has shortened since the pandemic.

Mailing a letter or sending an email may not count as injured worker contact. Email spam filters and the two-day minimum for a letter to arrive — if not longer — do not work nowadays.

If the first contact of the worker incurs a delay, the risk of a larger claim becomes apparent. I was unable to extract the dollar amount that delayed contact costs each employer.

Having an industrial-minded treating physician network has always been critical to claims cost. More employers now use a local treating physician network. The injured worker contact at the beginning of the claim shows up more often now as a contributing factor to claims cost.

Less than 15% of the claims we received since the beginning of 2023 experienced a delay in getting in contact with the injured employee. However, it takes only one out-of-control claim to heavily affect an employer’s risk profile.

Usually, with a delay of three days or more, the claims progressed in this manner:

• The injured employee has sought medical treatment.
• That medical treatment has now become the initial treating physician.
• Interactions have occurred between the injured employee and the employer.
• The injured worker has no idea what benefits are available because she has not heard from the adjuster.

Bottom line

I have presented and written many articles on quick initial contact. The claim is set and basically over in 48 hours. The injured worker contact needs to be a phone call, not an email or a letter/postcard.

Of course, if the employee has sought legal representation, 24-hour injured worker contact will have to go through the attorney.

As always, go with your company’s claim processing manual. While you are there, check out some of the other instructions on how your carrier or third-party administrator wants the claims adjusted as they progress, such as claims diaries. 

Check out the Six Keys to Workers' Comp savings. The article is 17 years old but still works today.

This blog post is provided by James Moore, AIC, MBA, ChFC, ARM, and is republished with permission from J&L Risk Management Consultants. Visit the full website at www.cutcompcosts.com.